Injury problem a lingering issue for Nationals

At Nationals Park, Bryce Harper took his latest step back to the lineup with a workout. Starting pitcher Dan Haren planned to receive an MRI on his stiff right shoulder. The Nationals held their breath that Jayson Werth's groin strain would turn out to be nothing.

Along with underperformance and roster changes, injuries have turned the Nationals from a preseason favorite to a team flirting with .500. Ten Nationals players, including stars Harper, Stephen Strasburg, Ryan Zimmerman and former Orioles draft pick Werth, have missed a combined 272 games on the disabled list this season. Last year, the Nationals lost more than 1,200 total days to the disabled list, ninth-most in the majors, according to data compiled by FanGraphs.com.

The rash of injuries has placed the Nationals' medical staff under scrutiny, but the degree to which it is culpable is unclear. Given the chance, no Nationals players interviewed for this story pointed blame at the team's doctors and trainers. Instead, they and other major league medical personnel pointed at the elusiveness of medical diagnoses and the randomness of injuries.

"If you individually look at these guys, each of these guys had a reason that we can't really control," Nationals medical director Wiemi Douoguih said. "Personally, as medical director, I feel confident we've been doing everything to make sure that these guys are healthy. We've had some bad luck."

Added Werth, the right fielder who missed 28 games on the disabled list with a hamstring strain: "It's nobody's fault. It's tough to point fingers. It's the just the way we are. We're stubborn ballplayers. We're not going to change."

The seemingly erratic timeline of several injuries has given the perception of mishandled diagnoses. In early May, Werth felt a twinge in his right hamstring, missed two games, returned after a "day-to-day" diagnosis — and then did not play for another month. Harper toggled in and out of the lineup after he suffered left knee bursitis following his collision with an outfield fence at Doders Stadium on May 13. On May 27, the Nationals labeled Harper's injury "day-to-day." He has not played since.

"Everything we're doing is part of a plan," Douoguih said. "There's literature to support the things that we're doing. Every once in a while, these things just happen. I really think we try to be cautious. I know that the front office sometimes wants to get guys out quick, but they respect our decisions a lot of times."

Harper believes the Nationals handled his injury appropriately.

"I felt good enough to play," Harper said. "Could I have done it different? Yeah, personally I could have. I think I tried to play through it. Everything they did was right on. It was all good from there."

Douoguih also said the Nationals' disabled list track record has been skewed by certain players. The Nationals signed Christian Garcia knowing he had undergone three elbow surgeries earlier in his career and represented a risk; this year, he has missed all 75 games on the disabled list because of a partially torn forearm tendon. The rate of hamstring issues for players coming off anterior cruciate ligament surgery is higher than normal, Douoguih said, and catcher Wilson Ramos has missed 49 games after suffering two hamstring strains. Reliever Ryan Mattheus broke his right hand when he punched a locker.

"We can't baby-proof the field and the clubhouse," first baseman Adam LaRoche said. "Stuff's going to happen. It's nothing with training or stretching. We're doing the same stuff we've done for years — the same stuff all the other teams do. Some stay healthy. Some have bad luck. Hopefully we're getting it out of the way now."

After deciding against offseason surgery to repair a torn rotator cuff in his left shoulder, second baseman Danny Espinosa began another health ordeal when a fastball hit him in the right wrist April 14; that led him to play through a fracture, land on the disabled list and get optioned to Triple-A.

Espinosa declined to discuss the Nationals' treatment of his injuries. "That would only get me in trouble," he said in early June before he went on the DL.

Douoguih said the fracture showed up on Espinosa's original X-ray but it carried the symptoms of a bruise. He still passed strength tests and felt no pain in the area of the fracture. Douoguih chalked up the fracture to an old injury that had healed or become irrelevant to Espinosa's performance.

"If you took everybody in that room that plays the infield, I'd be willing to bet that 75, maybe 80 percent have an old fracture in their hands or fingers, or have had hamate [wrist] surgery, or both," Nationals athletic trainer Lee Kuntz said. Kuntz believes the pain Espinosa felt from the bone chip might have been triggered by a hard swing he took in late April, about 10 days after the pitch hit him in the wrist.

The uncertainty of diagnosing injuries can collide with the challenge of describing them in a public forum. The chain of communication from the Nationals training staff to manager Davey Johnson to the media and ultimately fans often leads to confusion.

"There's no question that there are challenges in communicating, because we all have different backgrounds," Douoguih said. "Davey came up as a player, then a manager. Back when they played, they didn't have doctors giving MRIs, things like that. They just went out there until they busted."

The Nationals have made efforts to upgrade their medical care. They have established contracts with a bevy of specialists for each part of the body. Last year, the Nationals lost Ian Desmond, Mark DeRosa and Jhonatan Solano to the DL after they suffered strained obliques from swinging.

This offseason, Douoguih and his staff instituted a new protocol.

"We tweaked our program to try to address that, to have a graduated swinging program, so guys aren't coming in cold," Douoguih said. "Not every team has that. But this is something we were trying to do to be proactive."

No Nationals hitters have suffered oblique injuries this year, but the team's best efforts have not kept other injuries from derailing them.

Baseball's schedule punishes unhealthy teams, and whether because of bad luck or bad practices, it has been particularly unkind to the Nationals.

"When you look at other sports like the NFL, they got a week to determine what's going to happen," Kuntz said. "The guys gets hurt on Sunday, they got till Thursday until they got to put anybody on a list. We're playing every day. People play here with chronic conditions all the time. This is a war of attrition. It's not always the best team in the end. It's the best team left standing."